kuliah antihipertensi

36
Farmakoterapi Hipertensi Edy Junaidi

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Page 1: Kuliah Antihipertensi

Farmakoterapi Hipertensi

Edy Junaidi

Page 2: Kuliah Antihipertensi

Factors involved in the pathogenesis of hypertension

Straka, R.J., et al., 2008

Page 3: Kuliah Antihipertensi

Saseen, J.J. & Carter, B.L., 2005

Page 4: Kuliah Antihipertensi

JNC7JNC7

Page 5: Kuliah Antihipertensi

JNC 7

ESC/ESHESC/ESH

Page 6: Kuliah Antihipertensi

ESC/ESH Guidelines, 2007ESC/ESH Guidelines, 2007

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Goal BP Value Recommended by the JNC7

Most patients < 140/90 mmHg Patients with diabetes < 130/80 mmHg Patients with Chronic Kidney Disease <

130/80 mmHg Estimated GFR < 60 ml/min Serum creatinine > 1.3 mg/dl in women

or >1.5 mg/dl in men, or Albuminuria > 300 mg/day, or ≥ 200 mg/g creatinine

Page 8: Kuliah Antihipertensi

Initiation of Antihypertensive Treatment(ESC/ESH Guideline, 2007)(ESC/ESH Guideline, 2007)

Page 9: Kuliah Antihipertensi

Classification of Antihypertensive drugs by Their Primary Site or Mechanism of Action Diuretics

Thiazides & related agents Loop diuretics K+-sparing diuretics

Symphatolytic drugs Centrally acting agents (methyldopa, etc) Adrenergic neuron blocking agents (guanadrel,

reserpine, etc) Beta-blockers Alpha-blockers Mixed adrenergic antagonists (labetalol, carvedilol)

Vasodilators Arterial (Hydralazine, Minoxidil, diazoxide, fenoldopam) Arterial & Venous (Nitroprusside)

Page 10: Kuliah Antihipertensi

Calcium channel blockers (CCB) Dihydropyridine (nifedipine, amlodipine, etc) Verapamil & Diltiazem

ACE Inhibitors Captopril, enalapril, etc

Ang II receptor Blockers (ARB) Valsartan, Losartan, etc

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Lüllmann, H., et al., 2005

Page 12: Kuliah Antihipertensi

Lüllmann, H., et al., 2005

Page 13: Kuliah Antihipertensi

Lüllmann, H., et al., 2005

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1 = ACEIs; 2 = ARBs; 3 = Beta-blockers; 4 = CCBs; 5 = Diuretics; 1 = ACEIs; 2 = ARBs; 3 = Beta-blockers; 4 = CCBs; 5 = Diuretics; 6 = Aldosterone antagonists6 = Aldosterone antagonists

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66

Saseen, J.J. & Carter, B.L., 2005

Page 15: Kuliah Antihipertensi

Diagram of Renin – Angiotensin – Aldosterone System (RAAS)

Straka, R.J., et al., 2008

Page 16: Kuliah Antihipertensi

Flowchart of various Beta-Blockers

Straka, R.J., et al., 2008

Page 17: Kuliah Antihipertensi

There are some controversies exist There are some controversies exist on diuretics and Beta-blockers as on diuretics and Beta-blockers as first-line therapyfirst-line therapy

Saseen, J.J. & Carter, B.L., 2005

Page 18: Kuliah Antihipertensi

Saseen, J.J. & Carter, B.L., 2005

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Clinical trial & guideline basis for compelling indications for individual drug classes

Adapted from JNC7, 2004Adapted from JNC7, 2004

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Cutler, J.A & Davis, B.A., 2008

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Incidence of hospitalized (Hosp) Heart Failure (HF) outcome by Antihypertensive Treatment Group (Amlodipine/Lisinopril vs. Chlortalidone)

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Preferred drugs in related conditionsLVH = left ventricular hypertrophyESRD = end-stage renal disease /

renal failureISH = isolated hypertensionACEI = ACE inhibitorCA = Calcium antagonist / CCBARB = Angiotensin II receptor

blockerBB = Beta-blockers

ESH/ESC guideline, 2007

Page 23: Kuliah Antihipertensi

ESC/ESH guideline, 2007

Page 24: Kuliah Antihipertensi

Possible combinations between some classes of antihypertensive drugs.The preferred combination in the general hypertensive population are represented as Thick Line. Thick Line. The frame indicate classes of agents proven to be beneficial in controlled intervention trialsESC/ESH Guideline, 2007

Page 25: Kuliah Antihipertensi

Rate of persistence on treatment after 6, 12, and 24 months in difference subgroup of patients treated with ARBs, CCBs, BBs, ACEIs,Lercanidipine, & Diuretics* ** *** p<0.05, 0.01, 0.005 vs ARBs

Veronessi, M., et al., 2007

Page 26: Kuliah Antihipertensi

Adverse Effects of drugs : percentage of people with one or more symptoms attributable to treatment*; according to category of drug and dose

in randomized trial

Bramlage, P. & Hasford, J., 2009

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Kesselheim, A.S., et al., 2008

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Bourgoult, C., et al., 1999

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Bourgoult, C., et al., 1999

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Bourgoult, C., et al., 1999

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Fischer, M.A. & Avorn, J., 2004

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Monthly cost of antihypertensive drugs in UK was found £23.44

Hypertension expenditures in Italy represents 42.7% of total expenditure for medicines

Page 36: Kuliah Antihipertensi